Healthcare Provider Details

I. General information

NPI: 1063853034
Provider Name (Legal Business Name): NEDRA KANE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 5254A
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 5254A
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4200
  • Fax: 937-208-2678
Mailing address:
  • Phone: 937-208-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN.CNS.14742
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: